Brand Name Drug

Copayment (Copay)

The portion of the medication cost that the member is responsible for paying when filling a prescription at a participating network pharmacy. The copay amount may vary based on which type of drug is chosen and the structure of the plan’s benefits.

Drug Compounding

Compounded drugs are drugs that have been combined according to a unique recipe to produce a formulation that is not readily available or approved by the Food and Drug Administration, to suit a particular patient’s needs.

Formulary

Generic Drug

Chemical equivalent of a brand name drug. Generics are typically less expensive, contain the same active ingredients as a brand name drug, and produce the same outcomes as their brand name counterparts.

Grievance

A complaint submitted to the pharmacy benefit manager by, or on behalf of, the affected member regarding a problem or issue.

Lifestyle Drugs

Mail Service Provider

A pharmacy that dispenses medication through a shipping service to the home or office of the member receiving the prescription. This service is typically used by individuals who take one or more medications over an extended period of time.

Maintenance Medications

Drugs used to treat chronic diseases or conditions, and taken on a long-term basis.

Multi-source Brand

A drug product manufactured by more than one company or source. Multi-source drugs are those that are available both as the brand-name drug, and as generic equivalents or generic alternatives.

Pill Splitting

Cutting prescription medications in half to double the number of days’ supply from one prescription.

Preferred Brands

Brand-name drugs included on a plan's formulary.

Preferred Drug List (PDL)

The list of drugs covered by a prescription plan. Also known as a formulary.

Prior Authorization (PA)

A process where additional information must be provided or criteria must be met before certain medications can be dispensed. The criteria for which drugs require a PA are established by the plan sponsor.

Specialty Pharmacy Benefit

Step Therapy

Treatment guidelines used to recommend drug therapy beginning with the least expensive therapy. More expensive therapies are only used when the patient fails to respond to the first-line drug or after a Prior Authorization.